the nominations form

The Chancellor’s Medal 2015
Nomination for the Chancellor’s Medal 2015
Please fill in this form in as much detail as possible, preferably typed or in dark ink
(this form will be photocopied). You may attach additional sheets / supporting
documentation if necessary.
Nominee Details:
Name _____________________________________ Registration No. ____________________
Programme Studied ___________________________________ Level of Study* ___________
*Open to all final year undergraduate students, postgraduate students completing
their programme of study or research, or recent graduates of the University.
Supporting Statement (demonstrating outstanding attainment in academic,
sporting or other personal achievements):
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Nominator Details:
Name(s): _____________________________________________________________
Address: _____________________________________________________________
Contact Email:
Signature: _______________________________
Telephone: ______________
Date: _______________________
Please send the completed form to:
Jackie Parkin, Taught Programmes Office, Level 6, Students’ Union, Western
Bank, Sheffield, S10 2TG.
The closing date for nominations is 30 April 2015 and you should expect to hear
whether or not your nomination has been successful by the end of June 2015.
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